Aletaha Daniel, Smolen Josef S
University of Vienna, Vienna, Austria.
Arthritis Rheum. 2002 Apr 15;47(2):181-8. doi: 10.1002/art.10266.
To develop and validate evidence-based recommendations for routine laboratory tests in patients with rheumatoid arthritis (RA) receiving traditional disease-modifying antirheumatic drugs (DMARDs), and to calculate the monitoring costs.
Outpatient charts of 362 RA patients taking DMARDs were reviewed, and all laboratory abnormalities recorded. Recommendations on monitoring DMARD therapy were derived and then tested in an independent validation cohort of 231 patients. Cost analysis was performed using a cost catalog.
Laboratory abnormalities were seen in 10% of treatment courses; relevant abnormalities were seen only during the first 4 months of therapy. Laboratory tests should be performed in week 2 and 4, then monthly for the first 4 months of therapy, then 2 to 4 times per year. These were capable of detecting 98.3% of laboratory abnormalities in a timely manner in another RA cohort. Up to 78% of costs can be saved when the presented recommendations are compared with those of international rheumatology societies.
Laboratory tests can be reduced substantially in patients receiving DMARD therapy. In consequence, costs can decrease significantly without oversight of adverse events.
为接受传统改善病情抗风湿药物（DMARDs）治疗的类风湿关节炎（RA）患者制定并验证基于证据的常规实验室检查建议，并计算监测成本。
回顾了362例服用DMARDs的RA患者的门诊病历，并记录所有实验室异常情况。得出DMARD治疗监测的建议，然后在231例患者的独立验证队列中进行测试。使用成本目录进行成本分析。
10%的治疗疗程出现实验室异常；相关异常仅在治疗的前4个月出现。应在第2周和第4周进行实验室检查，然后在治疗的前4个月每月进行一次，之后每年进行2至4次。在另一个RA队列中，这些检查能够及时检测出98.3%的实验室异常。与国际风湿病学会的建议相比，采用本研究提出的建议可节省高达78%的成本。
接受DMARD治疗的患者实验室检查可大幅减少。因此，在不影响不良事件监测的情况下，成本可显著降低。
